| NPI | 1497921506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: NY 20055588) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202208228) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2015-09-28 |